Incentives for switching patients from branded drugs to generic

There’s an interesting video from WCVB in Boston about doctors getting kick backs from the insurance company to switch patients from branded medications to generic medications: New Rules To Protect Prescription Drug Customers.

If people were concerned about undue influence when drug companies used to give physicians pens and other novelties (now currently banned by most companies), they should really be concerned about actual monetary payments.

The patient interviewed in the Boston piece stated his doctor wanted to switch him from Lipitor to generic simvastatin (both cholesterol lowering medications), but did not mention that he was being payed by his insurance company to do so.

Though this is the first case I have heard of doctors being incentivized to switch patients to generics, it happens in pharmacies all the time. What is horrible is that some pharmacies may switch patients to alternative medications even if that switch costs the patient more money.

Switching to generics is itself not a bad things. I have blogged before that, for most medicines, generics are just as good as brand name medicines. For example, if the patient were on Zocor, a switch to the generic simvastatin would probably make a lot of sense, since the medications are basically equivalent and it would likely save the patient some money. However, in some cases, the small differences may actually make a difference.

In this particular case, the therapeutic switch from Lipitor to simvastatin might have been devastating since Lipitor is a much stronger medication. The piece does not say what dose the patient was on, but if the patient required Lipitor 40mg or 80mg, no dose of simvastatin would have given him the cholesterol lowering he needed.

What should you do?

1. If you are on a branded medication, ask your doctor if there is a generic equivalent of the exact same medicine, or one that works just as well.
2. If you are on a branded medicine and asked to switch to a generic by your doctor, find out why he or she wants to switch.
3. If you are on a branded medicine and asked to switch to a generic by your pharmacy, find out why they want you to switch. Is your insurance company asking for the switch? Is the medicine the same (generic substitution) or slightly different (therapeutic substitution)?

Regardless, make sure that you check with your doctor before switching any medicine.

Matthew Mintz is an internal medicine physician and blogs at Dr. Mintz’ Blog.

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solo dr

Most of the time simvastatin or pravastatin works just as well as Lipitor or Crestor, saving the patient hundreds of dollars annually in copays. Half the time patients tell me they take their lipitor every 2nd or 3rd day, as they cannot afford $60 a month in copays. Generics save office staff from wasted time prior authorizing brand name drugs. Most of the brand name drugs are simply advertised and pushed to docs and patients without years of proven benefit. Very few generics get recalled from the market.

Angela Caffaratti, MD

High dose Crestor splits nicely in fourths, but simvastatin and pravastatin are my first choices.

Jimmy Peanut

I believe that Dr Mintz is mistaken on his point about pharmacies preforming therapeutic substitutions without doctor or patient consent. While I’m not familiar with where Dr Mintz practices, I can assure him (and everyone else reading this) that there is (to my knowledge) no state in the US that allows pharmacists to legally switch a patient to a completely different drug (ie from Lipitor to simvastatin) without the doctor’s consent. The exceptions to that are the Veterans Admistration (because they operate on a strict formulary system that doctors are expected to follow) and in some hospitals (again due to predetermined formularies). Generic substitution and therapeutic substitution are completely different from one another from a pharmacy law point of view. Generic subsitution (ie Zocor to simvastatin) is legal without patient or doctor consent, and while there a few circumstances that brand name medications might cost less for patients with insurance (because the insurance company and drug company have negotiated a deal), that is certainly the exception and not the rule. Again, therapeutic substitution in a community pharmacy is not legal without doctors’ consent.

Max

You know something? The author’s main point is correct. You physicians know what he is talking about. You are scored. Your GUR (Generic Use Rate) that you get from your physician organizations then are used to score you compared to your peers. The higher your GUR, the higher your ‘kickback’, I’m sorry…reward. Don’t pretend like you don’t know what he is talking about. If you are low on the GUR, and your per patient cost is higher, if you are in the bottom tier, you may be summarily dismissed from your PO. Stop beating around his argument, he’s right. They get rewarded for higher GUR. And you don’t get your ‘good boy’ $$ if you’re lower in the tier. That’s the truth, patients.

Marc Gorayeb, MD

Outlaw the pens, post-it notes and pizzas, but do nothing about those who actually incentivize physicians financially to do their bidding? Why does this not surprise me? The command economy in medicine is just beginning. Remember, they’re smarter than we are.